I write in response to the Informatics Column of August, 2008 titled, “The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves?”

I have read many articles regarding the readiness of the health profession to use, exclusively, electronic health records (EHRs). Advantages of EHRs are that they provide continuity to patient care, reduce duplicate tests, decrease the time it takes to be diagnosed and treated for illnesses, and improve the bottom line for healthcare organizations.

I believe that nurses are intelligent and willing to move ahead in adopting EHRs. These records can make nurses’ assessments and care more efficient. Nurses have always taken on new challenges to improve the quality and safety of patient care. However, there are aspects of the EHRs that are of concern to me.

My primary concern is that as EHRs become common, nurses, too, will have their health information stored in an EHR. This means that their medical history would conceivably be available at the touch of a button. As more and more healthcare organizations begin to use EHRs, all healthcare encounters will be included in the EHR. Ambulatory care visits, mental health visits, and surgical procedures will all be available electronically. Additionally, findings from laboratory and radiography studies will also be accessible to all physicians, nurses, and healthcare providers.

I am concerned about the rights and privacy of nurses, especially those who have been diagnosed with diseases, such as HIV/AIDS, Hepatitis B, and/or mental illness. Nurses who have been injured on the job by giving care to other human beings could be considered a liability to healthcare organizations if their medical record shows a musculoskeletal injury or laminectomy. It occurs to me that personnel making hiring decisions may have access to all employee health records. If this occurs, would the hiring manager use a nurse’s health record to decide whether or not the nurse would be hired, just as in the case of background checks and drug testing data that are currently used as a condition of employment? Prospective employers’ access to private health data could be used to violate a nurse’s right to privacy, discriminate against, and not hire these nurses. The United States government has gone to great lengths to protect the privacy of patients’ medical information with the introduction of HIPAA. We might assume that accessing confidential data would not occur because HIPAA dictates that accessing a patient’s medical information without their express written consent would be illegal and unethical. The fact of the matter is that all of our healthcare information could, theoretically, be accessible to everyone who had access to the EHR. In addition, unethical people exist in every discipline, including healthcare. It would be difficult to prove that one’s health records were accessed and that inappropriate access to their personal health information was the reason a specific nurse was not hired for a given position. Trying to prove that a hiring manager viewed prospective nurses’ health data would be almost impossible unless someone from inside the organization would speak out, by which time nurses would have experienced severe financial losses due to the fact that a hiring manager had accessed their health records.

Another legal concern, now that EHRs are in use, is that companies offering the software for EHR’s are maintaining ownership of the software and all of the information that is on the software. One’s health history could legally belong to the information technology companies. To date, this has not been problematic in healthcare; but as EHRs become increasingly common, such possibilities must be addressed. As I write this letter, there are few nursing positions available due to the economic state of our country. Healthcare organizations have the luxury of picking the most desired nurses to work for them. Where does this leave the nurses who have battle scars from a lifetime of service and care of others? Where does this leave nurses who may have a history of infectious diseases, mental illness, and/or specific surgeries, or even older nurses? Now is the time to address these concerns. As President Obama has called for our healthcare system to be totally electronic by the year 2013, legislators must address the issues of nurses’ rights to privacy and amend the HIPAA law so that as patients stay protected, nurses will also be protected from discriminatory hiring practices by healthcare organizations.